ObjectiveTo analyze the related factors and clinical features of cerebral palsy in twin or multiple pregnancies. Methods52 cerebral palsy children in twin or multiple pregnancies were reviewed with the risk factors in perinatal period, the clinical type, findings of radiology and the gross motor function (GMFCS). Results and ConclusionNo significant link was found between these pregnancy complications and cerebral palsy in twins or multiple pregnancies. The prevalence of cerebral palsy was higher for the one with more birthweight in twins of the same gender. Spastic diplegia was the most type, and most of them were found with periventricular leucomalacia. The GMFCS levels was Ⅰ～Ⅲ in spastic hemiplegic or spastic diplegic children, while was Ⅳ～Ⅴ in children with spastic quadriplegia, dyskinesia or mixed CP.

Objective To investigate the intelligence level and characters in children with cerebral palsy of 4~6 years old, and the factors related with their intelligence. Methods 215 cerebral palsy children of 4~6 years old were assessed with Wechsler Intelligence Scale for children,Gross Motor Function Classification System (GMFCS). Results 210 children finished their intelligence test, and 113 presented mental retardation. The intelligence level was higher in the children with spastic diaplegia, hemiplegia and dyskinetic type than those with quadriplegia and ataxia type. The difference was significant between VIQ and PIQ in the spastic diplegia (P<0.05). The mental retardation was more frequent in the children with GMFCS Ⅳ~Ⅴ, or with epilepsy or microcephaly than those with GMFCS Ⅰ~Ⅲ or without the complications (P<0.05). Conclusion The incidence of mental retardation in children with cerebral palsy was related with the neurotypes, motor function and complications.

Objective To explore the effects of earlier oral-motor exercise on swallowing and feeding capability of children with cerebral palsy. Methods 36 children accepted oral-motor exercise performed by speech-language therapist once a day for 3 months. They were assessed for oral motor and feeding before and after treatment, and compared with other 36 controls matched with age and type. Results The oral motor in treatment group improved significantly （t=2.184,P<0.05） after treatment, but merely in control. The difference of scores of oral motor before and after treatment was (9.89±4.33) in treatment group, and (3.38±1.56) in control group (t=7.423, P<0.01). Conclusion Early oral-motor exercises is effective to improve oral motor function and feeding capability.

Objective To explore the clinical aspects and related EEG characteristics of epilepsy (EP) in children with cerebral palsy (CP).Methods The clinical data and the EEG Results of seizure-interictal-period in 84 CP children complicated with EP were collected and compared with the data of 124 CP children without EP.Results Among 84 CP children complicated with EP, 46 cases (54.76%) were partial seizures. Followed 26 cases (30.95%) were infantile spasms, 6 cases (7.14%) were tonic-clonic seizures. Spastic CP children tended to be the most patients seizures in EP, it was 82.14%. Children with teraplegia CP were the most type among the spastic CP children compliated with EP. The abnormal rate of EEG of CP children complicated with EP was significantly higher than that of CP children without EP ( P＜0.001), and local epilptiform discharges and multilocal epileptiform discharges were main types.Conclusion Partial seizures is the most epilepsy type in CP children complicated with EP, and spastic CP is the main type. EEG abnormal ratio is obviously higher in the CP children complicated with EP than the CP children without EP. The types of abnormal EEG are mainly local epilptiform discharges and multilocal epileptiform discharges.

Objective:To investigate the gross motor function, manual ability and language communication of children with cerebral palsy (CP) and their correlation.Methods:A total of 318 children with CP (132 with spastic diplegia, 27 with spastic quadriplegia, 32 with spastic hemiplegia, 54 with dyskinesia, 41 with ataxia and 32 children with multiple difficulties) aged 4 to 12 years were classified according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). Spearman correlation coefficients were used to analyze the correlation among the three ratings.Results:Only 125 of the 318 children (39%) had the same classification level according to all three scales, showing moderate correlation and different levels for patients with different types of disability. The GMFCS and MACS levels of the subjects with spastic quadriplegia and those with dyskinesia were highly correlated. The GMFCS and CFCS levels of the hemiplegic children and those with spastic quadriplegia were also highly correlated. The MACS and CFCS levels were strongly correlated for children with spastic quadriplegia and multiple disabilities.Conclusions:The functioning of children with CP differs with their CP subtype. Correlations among the three functional assessments also differ for children with different subtypes. Combining the three classification systems provides a more comprehensive picture of the children′s ability to function in daily life.

Objective To study the clinical features of visual dysfunction in children with cerebral palsy (CP) and related factors. Methods Between 2006 and 2009, one hundred and sixty-three children (aged 4 to 108months, mean age 29.05 ± 20.51 months) with CP at Qingdao's Rehabilitation Center for Disabled Children were enrolled into this study, including 117 boys and 46 girls. All the children were retrospectively reviewed for perinatal risk factors. Ophthalmologists examined their visual parameters, including refraction, visual acuity, eye position and movement, and fundoscopy. Results Among the 163 children, 61 had visual dysfunctions, an occurrence rate of 37.4%. They included refractive errors in 39 (23.9%) , strabismus in 50 (30.7%) , abnormal eye movement in 26(15.9%) , and abnormal fundoscopic findings in 13 (7.9%). Thirty-seven children's visual acuity was examined,and 19 of them (51.4%) had low visual acuity. Patients who showed periventicular leukomalacia (PVL) or lesions in the occipital lobe on MRI examination had a high incidence of visual dysfunction. Preterm and low birth-weight were risk factors for visual dysfunction in these CP children. Conclusions Visual dysfuntion is a common complication in CP children. Early ophthalmological assessment and intervention are important for CP children.

Objective To study the effect of octreotide on patients with postoperative acute adhesive small bowel obstruction. Method In this study, 87 patients with postoperative acute adhesive small bowel obstruction were divided into 2 groups: experimental group (46 patients) and control group (41 patients). Patients in the control group were treated with routine therapy, including gastrointestinal decompression, intravenous infusion, antibiotic and enema. Patients in the experimental group were treated with routine therapy plus somatostatin analogue (octreotide) 0.1 mg. ih q8 h. for 72 hour. The alleviation of abdominal symptom and sign and the possibility of surgical intervention are observed and compared.Results Compared to the control group, the obstruction in the experimental group alleviated significantly,the abdominal pain relieved, the amount of draining decreased, and the passage of gas was earlier.Conclusions Based on the routine therapy, the use of octreotide significantly relieves the symptoms of obstruction and shortens the course of conservative therapy.

Objective To study the topoanatomy of anterior perineal plane and adjoining tissue structure in the preparation of ultra-low anterior resection of the rectum. Methods Dissection was performed on 16 male cadavers of semi-pelvis sectioned in the saggital plane. Eight indexes were measured and recorded. Results Anterior perineal plane was clearly found in all 16 cadavers. The median distance of rectum-urethra (R-U) was 14 mm (ranging 10 -17 mm). The contour of perineal body was trapezoid,which was narrow cranially and broad caudally. The median width of cranial perineal body was 8 mm (ranging 6 -9 mm), while the median width of caudal perineal body was 21 mm (ranging 18 -23 mm).The median numerus of thickness of perineal body (TPB), thickness of puborectalis (TPR), arrterior wall of rectum (aPR) -D, pPR-D and width of pelvic diaphragm (WPD) were 20. 5 mm ( ranging 17 - 23 mm),12 mm(ranging 10 -16 mm), 25 mm(ranging 21 -27 mm), 20 mm(ranging 16 -23 mm) and 8 mm (ranging 6 - 10 mm) respectively. Conclusions Anterior perineal plane clearly exists, through which about 20 mm more length of the distal rectum is available which could increase the sphincter-saving rate in cases of low rectal carcinoma.

Objective To explore the clinical effect of laparoscopic colorectal radical resection combined with simultaneous laparoscopic or open major hepatectomy for synchronous colorectal liver metastases (SCRLM).Methods The retrospective cohort study was adopted.The clinical data of 14 patients with SCRLM who were admitted to the Peking University Third Hospital from July 2010 to September 2015 were collected.Seven patients undergoing total laparoscopic colorectal radical resection combined with major hepatectomy (TLCRMH) were allocated into the TLCRMH group and 7 patients undergoing laparoscopic colorectal radical resection combined with open major hepatectomy (LCROMH) were allocated into the LCROMH group.The statuses of colorectal cancer and metastatic lesions were detected by endoscopy and imaging examination,and diagnostic and therapeutic plans were confirmed through the consultation of muhidisciplinary team.During the hepatectomy,total liver ultrasonography was performed and the extent of liver resection was above 3 hepatic segments.The follow-up of outpatient reexamination was applied to all the patients once every 3 months within postoperative year 2 and once every 6 months after 2 years till December 2015.(1) During operation,method of liver resection,radiofrequency ablation (RFA),operation time,volumes of intraoperative blood loss and blood transfusion,pathological results of primary lesions (T stage,N stage,nerve invasion and canalis haemalis invasion) were collected.(2) After operation,duration of intensive care unit (ICU) care,time for fluid diet intake,postoperative alanine transaminase (ALT),total bilirubin (TBil),complications and duration of hospital stay were collected.(3) Survival of patients and recurrence of tumor were followed up.Count data were analyzed by the chi-sqaure test.Measurement data with normal distribution were presented as x ± s and analyzed using the t test.Measurement data with skewed distribution were described as M(Qn) and M(range) and analyzed using the Mann-Whitney U test.The survival curve was drawn by the Kaplan-Meier method,and overall survival rate and tumor-free survival rate were calculated.The survival analysis was done using the Log-rank test.Results (1) The status of operation:1 and 6 patients in the TLCRMH group underwent respectively left and right hemihepatectomies and 7 patients in the LCROMH group underwent right hemihepatectomy.Four and 6 patients in the TLCRMH and LCROMH groups received local resection of liver metastatic lesions or RFA at segment Ⅱ,Ⅲ or Ⅳ of liver,respectively.The operation time,volumes of intraoperative blood loss and blood transfusion were (651 ± 218)minutes,(1 387 ± 871)mL,(914 ±641)mL in the TLCRMH group and (535 ± 83) minutes,(1 357 ±991)mL,(857 ± 360) mL in the LCROMH group,respectively,with no significant difference between the 2 groups (t =1.320,0.060,0.206,P ＞ 0.05).The numbers of patients in T2,T3,T4,N0,N1,N2 stages,with nerve invasion and canalis haemalis invasion were 1,5,1,3,4,0,3,2 in the TLCRMH group and 0,4,3,1,4,2,2,3 in the LCROMH group,respectively,showing no significant difference between the 2 groups (x2=2.111,3.000,0.311,0.311,P ＞ 0.05).(2) After operation,time for fluid diet intake,ALT,TBil,number of patients with complications and duration of hospital stay were (4.3 ± 1.0) days,(105 ± 47) U/L,(34 ± 25) μmol/L,3 (Ⅲ a,Ⅲ b and Ⅳ a grades of Dindo-Clavien grade),(27 ± 21)days in the TLCRMH group and (4.3 ± 1.1)days,(113 ± 57)U/L,(26 ± 11) μmol/L,4 (Ⅰ,Ⅰ,Ⅱ and Ⅳ a grades of Dindo-Clavien grade),(19 ± 9)days,respectively,showing no significant difference between the 2 groups (t =0.079,-0.286,0.806,X2 =0.286,t =0.856,P ＞ 0.05).The duration of ICU care in the TLCRMH and LCROMH groups were (2.1 ± 1.6) days and (1.0 ± 0.6) days,with a significant difference between the 2 groups (t =1.804,P ＜ 0.05).(3) The status of follow-up:all the patients were followed up for 3-54 months,and the median follow-up time was 15 months (range,3-39 months) in the TLCRMH group and 30 months (range,11-54 months) in the LCROMH group.The 1-,3-year overall survival rates were 100.0％ and 100.0％ in the TLCRMH group and 85.7％ and 64.3％ in the LCROMH group,respectively,showing no significant difference between the 2 groups (x2 =0.676,P ＞ 0.05).The postoperative 1-,2-year cumulative tumor-free survival rates and overage cumulative tumor-free survival time were 64.3％,64.3％ and 20.5 months in the TLCRMH group and 42.9％,14.3％ and 10.9 months in the LCROMH group,respectively,showing no significant difference between the 2 groups (x2=3.160,P ＞ 0.05).Conclusion TLCRMH is safe and feasible for patients with SCLM,and it is comparable with LCROMH in the incidence of postoperative complication and long-term outcomes.

Objective To investigate the clinical characteristics of speech disorders in children with cerebral palsy (CP) and any relationship between those characteristics and cranial magnetic resonance images.Methods A sample of 138 children with CP were given the ＜ s-s ＞ language development test,a Chinese-language articulation test and oral motor scores to quantify their functional speech and articulation.The characteristics of their speech disorders,articulation and oral motor dysfunction were then related with abnormalities in their cranial magnetic resonance images (MRIs).Results Of the 138 MRIs,only 9 were normal.Three showed non-specific abnormalities (delayed myelination and/or broadening of the space outside the brain) and 122 (91％) showed specific abnormalities.Among the children with specific abnormalities,51.6％ had speech reception delay and 74.6％ had speech expression delays.The dysarthria rate was 71.3％,including 8.7％ with no speech ability at all.The main MRI abnormalities were lesions of the basal ganglia (23％),lesions of the cerebellum (11.5％),periventricular leukomalacia (PVL) (47.5％),extensive cortical or subcortical lesions (6.6％) and focal cerebral injury (11.5 ％).The corresponding oral motor scores increased successively.The children with lesions of the basal ganglia or cerebellum were most likely to manifest speech expression delay and dysarthria.The children with cortical or subcortical lesions or PVL also showed speech expression delay and dysarthria.However,the children who had a focal cerebral injury generally performed well on the speech ability assessment.Twelve children had no speaking ability at all,and in 7 of them the lesions were of the basal ganglia.Conclusions The probability and severity of speech disorders in children with cerebral palsy relate with specific abnormalities detectable with cranial MRI.Those with lesions of the basal ganglia or cerebellum will be more likely to show more severe speech disorders.